An estimated one billion people across the globe live in slums or informal settlements. As much of the world is already braced and battling with coronavirus crisis, there are others perplexed as to how this one billion people can possibly deal with the current pandemic. The general recommendations to global population are to wash your hands with soap and water for 20 seconds, if sick to self-isolate, and when out and about to practice social distancing of keeping 2 meters away from other persons. Three simple directives or are they?
How feasible are these recommendations for people living in informal settlements and slums?
As the pandemic is on the doorstep, there has been noticeably little discussion of how to combat the pandemic in slums and informal settlements around the world. How can these people groups deal with the looming threat of COVID-19? The answer is simply, they cannot. The virus is invisible but so are the health conditions of the residents along with the social needs of these communities.
The actual common health threats of the people living in these marginalized areas is undocumented and poorly understood by national authorities. Research has been conducted reviewing the post-Ebola urban health of the people in Sierra Leone. A second research initiative has also been conducted looking at the accountability of the informal urban equity information. From these two research projects, some insights have been made into the potential understanding of possible management of COVID-19 in these marginalized areas.
The key findings from previous epidemic studies include:
- Paucity of data and detailed information of the people residing in these areas.
- People from these informal settlements have strong interdependence with the population of immediately adjacent urban city.
- Extreme vulnerability to a wide range of potentially dangerous diseases and health issues.
- High levels of vulnerability to disease and undocumented ongoing health issues
- The level of order or chaos within the informal settlements would be very ill-defined to outsiders although it maybe very apparent and structured for the local residents.
A lack of demographic data
There are very large data gaps as the slums are very informal in layout and in many instances are illegal settlements. These two factors impede the collection of local data of the population living in such areas. It is so randomly organized that it is difficult to implement effective health and sanitary measures. There are no official population statistics of the number of persons actually living in these areas. Because there is no demographic data, it is impossible for epidemiological models to predict the likely spread of infectious disease.
Interdependence with adjacent urban centers
The informal settlement may even butt right up to a formal urban settlement. The residence of the informal settlement may have very close ties and associations within the formal settlement in terms of employment, both casual and regular in its nature of commitment and financial reimbursements.
This association with very different socio-economic neighbourhoods with a very high level of dependency makes it very difficult to implement and enforce containment and minimization of movement as the hired hands obviously return to their shanty lifestyle at the end of the work day. The dependency of the hired workers is critical for basic survival so quarantine measures are very unlikely to be put into effect and adhered to with any degree of success.
High levels of vulnerability to disease and undocumented ongoing health issues
The occupants of informal settlements often lack general knowledge of the type of illnesses and diseases that frequent these people groups. Health providers will be from within the informal sector and may be mainly traditional and herbal, or the dispensing of pharmaceutical medicines with minimal knowledge of the substances being used. This would be particularly the case for fevers and coughs.
The majority of people will lack having health issues correctly diagnosed and treated. Therefore, the inhabitants may very likely be living with chronic health conditions. It would be reasonable to assume that there may be very large pockets of highly vulnerable individuals that if a pandemic got into the mix, their lives would be highly threatened with limited support or potential care.
Food security would be a very real problem in such communities at different times depending on natural catastrophes and their highly variable financial means. This could affect their overall state of fitness and general health.
The degree of order or chaos
The level of and degree of internal structure and hierarchy will be concealed from outsider and organizations wanting to offer aid and assistance. Likewise the leadership could be any number of different personalities ranging from traditional healer, council member, business person, youth leader, gang member, and so on.
Therefore, planning intervention measures for the pandemic would be very complex and require time to establish connections, good rapport and understanding between the people within the informal settlement with organizations offering medical advice and services for handing the pandemic.
These living conditions could place the inhabitants at frequent occurrence of natural disasters and life threatening situations such as cholera, influenza, flooding, mudslides, and many other types of life threatening happenings.
Therefore, it is safe to say that community engagement would be essential but requires lead time to establish relationships and levels of trust between local residents and outside organizations wanting to work with the community.
Returning to the Covid-19 pandemic
This may well be a long-overdue turning point in many regions of the globe. Epidemics, and in this instance a pandemic, may be the trigger for the urban elite to reassess the plight of the informal settlement areas. Because there is a symbiotic dependency of both people groups and a potential threat to all lives by the poor levels of health and unsanitary living conditions, on the less desirable sector, action may finally be essential.
The threat of COVID-19 will be better managed in the more developed urban sectors. This means that the risks are both real and very high for these urban poor community groups. It may not be a favourable outcome for the present pandemic but it may open up the need for urban communities to take greater responsibilities for the informal settlement areas.
It may not be until after the passing of the pandemic, that the more structured sector will have to take more responsibility for redefining human redevelopment, ensuring improved and sustainable health conditions and standards of housing and overall living conditions in the present informal settlement area. This would be long-term improvements for the informal clusters that have been ignored for too long and must be addressed if humanity hopes to succeed through the coming centuries.
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